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Thoracic > SCLC > Flashcards

SCLC Flashcards

1
Q

non-smoker SCLC?

A

only 2-3% of cases. 98% from smoking. would re-biopsy and re-review if no smoking history

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2
Q

IHC markers

A

CD56, chromogranin, synaptophysin

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3
Q

TTF-1 in SCLC

A

positive in 70-80% cases

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4
Q

SCLC molecular

A

> 90% mutated for p53, Rb; diversity of genetic alterations with chromosomal instability

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5
Q

SCLC transformation

A

acquired resistance to EGFR TKI–> sensitizing mutation Exon 19 is retained but becomes SCLC, tx with EP

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6
Q

SCLC clinical

A

bone pain, SVC, paraneoplastic

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7
Q

paraneoplastic

A

cushing’s (5% of patients), SIADH, hypercalcemia (rare, mediated by PTHrP),

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8
Q

low Na at presentation

A

adverse prognostic factors, Tx chemo, ketoconazole, mitotane, adrenalectomy

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9
Q

SIADH in SCLC

A

10% of SCLC patients, symptoms in only half; Tx chemotherapy, fluid restrict, tolvaptan (oral V2 antagonist)

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10
Q

neurologic paraneoplastic

A

encephalomyelitis (anti-HU), retinopathy, lambart-eaton (ca channel mediated)

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11
Q

paraneoplastic

A

not effective treatments

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12
Q

lambert eaton syndrome

A

5% SCLC; proximal weakness improves with use; hyporeflexia, autonomic dysfcn, Tx IVIG, rituxan, plasmaphoresis

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13
Q

staging

A

30% with limited disease- found within one irradiation portal (can include a supraclav node); 70% extensive stage

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14
Q

survival

A

limited stage: 20mo survival, 20% cure; extensive: 10mo survival, no cure; untreated 2-4mo

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15
Q

treatment limited stage

A

concurrent chemorad better over chemo alone: sequential tx no benefit!

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16
Q

concurrent chemoRT

A

twice daily RT improved OS compared to once daily; standard of care. ongoing study to evaluate 45 v. 60Gy

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17
Q

surgery in SCLC

A

40-70% survival (stage I N0 small tumors, all pts get chemo as well either before or after, need mediastinoscopy; remove entire lobe, if nodal met, give adjuvant chemoRT)

18
Q

standard metastatic

A

EP: etoposide + cisplatin

19
Q

cis/etop v. carbo/etop

A

interchangable, both can be given with RT; meta-analysis shows equivalent

20
Q

irinotecan/cis v. etop/cis

A

both similar survival and PFS and ORR: trade-of GI toxicity for heme toxicity: EQUIVELANT

21
Q

UGT1A1 and irinotecan

A

makes more toxic

22
Q

brain mets SCLC

A

18% of pts at presentation, 80% at 2 years, standard of care: 25Gy/10Fx or 30Gy/15Fx, given after systemic therapy, give within 6-8wks, do MRI before;

23
Q

second line treatment

A

topotecan only (can be oral), OS 6 months von Pawel JCO 1999; improved control of symptoms

24
Q

SCLC epi

A

13% of lung cancer cases, 10mo OS extensive, 20mo limited stage

25
Q

paraneoplastic syndroms: SIADH with SCLC

A

from vasopressin or Atrial natureitc cactor

26
Q

SCLC- cushing’s

A

ACTH, late stage of disease, refractory hypoK

27
Q

hypercalcemia for SCLC

A

rare, from PTHrP, more often in SCC

28
Q

SIADH with SCLC

A

symptoms in 5% only. Tx- chemotherapy!, can restrict fluid, give salt, demeclocycline–>from a nephrogenic DI that counteracts, tolvaptan (oral)–>have to be careful because pts are sensitive, have to start it in hospital.

29
Q

neurologic paraneoplastic with SCLC

A

can precede Dx of SCLC for months, not related to tumor bulk, have improved survival! symptoms do not resolve with chemo, little other treatments (irreversible damage)

30
Q

Lambert-Eaton

A

related to SCLC, ab against voltage-gated channels, get EMG test

31
Q

anti-Hu with SCLC

A

encephalomyelitis

32
Q

SCLC genetics

A

90% have mutations against p53 and Rb, 27% have SOX2 amp, 10% PTEN must,

33
Q

SCLC presentation

A

often BM infiltration, nucleated RBC, neutropenia/thrombocytopenia. get MRI brain/ CT Chest with liver/adrenals

34
Q

Staging of SCLC

A

limited: tumor confined to radiation port (can include ipsi supraclav LN, but NOT pleural effusion); extensive: not

35
Q

TNM staging SCLC

A

eh

36
Q

limited stage treatment

A

cis/etop (4-6) with concurrent RT upfront (45Gy /BID or 63Gy/day)

37
Q

extensive stage treatment

A

cis/etop x 4 (or carbo)

38
Q

second line SCLC

A

topotecan or CAV, irinotecan, taxol/doce, gem, vino, temodar

39
Q

SCLC after PR/CR to first line Tx

A

prophylactic WBRT, monitor with CT scan (if 3yr+, cure 95%)

40
Q

primary refractory SCLC

A

topotecan or CAV

41
Q

old and fit

A

still give cis/etop

Thoracic (3 decks)

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